Digital mental health policies in 40 countries: a comparative content analysis based on the availability, accessibility, acceptability, and quality framework

With the rising global burden of mental disorders and the rapid advancement of digital health technologies (DHTs), digital mental health policies play an important role in guiding the integration of DHTs into mental health services. Yet comparative analyses across countries at different income levels remain limited. This study conducted a comparative analysis of 113 policy documents from 40 countries, with ten countries from each World Bank income group. Documents were analyzed using a 14-dimension framework based on the Availability, Accessibility, Acceptability, and Quality (AAAQ) framework. We examined document coverage, the relative distribution of coded references across income groups, and country level coverage of policy content. A total of 1,270 coded references were identified and grouped into 66 subthemes. Policy publication increased after 2020, peaking at 21 documents in 2023. Most documents addressed digital health (49.6%) or mental health (24.8%) broadly, while only 14.2% focused specifically on digital mental health. The most frequent dimensions were “information” (covered 71.7% of documents, 14.1% of references), “service availability” (69.9%, 12.9%), and “ethical issues” (70.8%, 12.8%), whereas “attractiveness” (17.7%, 2.7%), “quality​ of connection” (23.9%, 3.4%), “digital literacy” (32.7%, 3.9%), and “usability” (31.0%, 4.0%) were less frequently addressed. Cross-income comparisons revealed descriptive differences in the relative composition of policy content. Compared with the other income groups, foundational capacity was comparatively prominent in low-income groups (LICs), service availability in middle-income groups (MICs), and attractiveness, usability, ethical issues, and science evidence in high-income groups (HICs). Country-level coverage also varied both across and within income groups. Australia was the only country with digital mental health specific policy content across all 14 dimensions, whereas none of the dimensions had such coverage in the included Russian documents. Several middle-income countries, including India, Thailand, and Ukraine, showed broader coverage than some high-income countries. This study provides one of the first cross-national comparative analyses of digital mental health policies across 40 countries. Infrastructure, service availability, and ethics received substantial attention, while user experience and digital literacy received limited attention. Compared with other income groups, LICs focused on foundational capacity, MICs on service expansion, and HICs on ethics and user-centered quality. Differences across and within income groups highlight the need for context-sensitive policies that strengthen foundational capacity and service provision while addressing acceptability and quality.